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Purpose: To determine whether fluid-fluid exchange (endodrainage) or external needle drainage can result in retinal displacement following minimal gas vitrectomy (MGV) with no fluid-air exchange for rhegmatogenous retinal detachment repair. Methods: Two patients with macula-off rhegmatogenous retinal detachment underwent MGV with and without segmental buckle. First case had MGV with segmental buckle (MGVSB), along with endodrainage, whereas the second case had MGV only with external fluid drainage. At the completion of surgery, the patient was immediately log rolled to face down for 6 hours followed by positioning to the break. Results: Both patients achieved retinal reattachment, and postoperative widefield fundus autofluorescence imaging demonstrated a low-integrity retinal attachment with retinal displacement. Conclusion: Iatrogenic fluid drainage techniques, such as fluid-fluid exchange or external needle drainage during MGV (without fluid-air exchange), may result in retinal displacement. Allowing the retinal pigment epithelial pump to reabsorb the fluid naturally may reduce the risk of retinal displacement. [ABSTRACT FROM AUTHOR]

Background: Few large randomized controlled trials provide strong evidence to guide surgical repair of primary rhegmatogenous retinal detachment (RRD) repair. The purpose of this factorial, single-blind, randomized controlled trial is to analyze and compare the surgical outcomes, functional visual outcomes, complications, and quality of life associated with RRD repair using (A) pars plana vitrectomy only (PPV) or PPV with scleral buckle (PPV-SB) and (B) sulfur hexafluoride gas (SF6) or perfluoropropane gas (C3F8) tamponade. Methods: Eligible patients with moderately complex RRD will be randomized 1:1 to PPV or PPV-SB and 1:1 to SF6 or C3F8 gas tamponade. Approximately 560 patients will be recruited to be able to detect a difference of around 10% in SSAS rate between the groups. Patients will be followed using multimodal imaging and quality of life questionnaires after the surgical repair until 1 year postoperative. The primary outcome will be a single-surgery anatomic success (SSAS), defined as the absence of reoperation for recurrent RRD in the operating room. Secondary outcomes will be pinhole visual acuity (PHVA) at 8–10 weeks and 6 months, final best-corrected visual acuity (BCVA), final retina status (i.e., attached or detached), time to onset of RRD recurrence, severity and number of complications, and questionnaire results. Discussion: This will be the first 2 × 2 factorial RCT examining repair techniques in primary RRD. It will also be the first RCT to compare gas tamponade between the two most common agents. Notably, it will be adequately powered to detect a clinically significant effect size. The use of multimodal imaging will also be a novel aspect of this study, allowing us to compare head-to-head the impact of adding an SB to the retina's recovery after RRD repair and of differing gas tamponades. Until now, the treatment of RRD has been largely guided by pragmatic retrospective cohort studies. There is a lack of strong evidence guiding therapeutic decisions and this trial will address (1) whether supplemental SB is justified and (2) whether longer duration gas tamponade with C3F8 is necessary. Trial registration: ClinicalTrials.gov NCT05863312. Registered on 18 May 2023. [ABSTRACT FROM AUTHOR]

Background The appearance of hyperfluorescent lines next to the retinal blood vessels after successful retinal detachment (RD) surgery was explained by the occurrence of retinal displacement. This can attribute to the metamorphopsia experienced by some patients after their surgeries. Patients and methods A prospective interventional study was performed that included 30 eyes of 30 patients with primary rhegmatogenous RD, who had undergone successful RD surgery via pars plana vitrectomy and silicone oil tamponade. The entire patients had preoperative and postoperative fundus autofluorescence and optical coherence tomography. They were followed up for 3 months after surgery with testing of the best-corrected visual acuity and Amsler grid testing. Results The mean age of the included group was 53.7±9.2 years, and 17 (56.7%) patients were males. The most frequent tear site was upper temporal (43.3%), followed by multiple peripheral (23.33%), upper nasal (13.3%), lower temporal (13.3%), and the least was lower nasal (6.7%). Retinal displacement was detected by hyperfluorescent lines adjacent to the retinal blood vessels in the fundus autofluorescence imaging in 16 eyes (53.3% with 95% confidence interval: 36.7–70.0%). Patients with retinal displacement were significantly younger than patients without (P=0.019). The presence of proliferative vitreoretinopathy was significantly related to the occurrence of displacement (P=0.028). Metamorphopsia was significantly more frequent among patients with displacement (P

Retinal displacement following the repair of rhegmatogenous retinal detachment (RRD) has been reported in recent studies. It was described as vertical movement of the retinal relative to its original location, as evidenced by retinal vessel printing on fundus autofluorescence imaging. This review reports the current literature on retinal displacement. We conducted an English literature search using Medline, PubMed, Embase, and Web of Science. We have reviewed 22 articles describing the diagnosis, frequency, and possible risk factors for retinal displacement. The reported rate of retinal displacement ranged from 6.4% to 62.8%, and the possible risk factors included the detachment-to-repair time, location and extent of RRD, macula-off RD, presence of subretinal fluid, use of perfluorocarbon, use of tamponade, postoperative facedown positioning, type of RRD repair, and presence of proliferative vitreoretinopathy, especially high grade. This review increases awareness of retinal displacement and its associated visual effects.

Abstract Introduction Pneumatic retinopexy (PnR) was proposed as an alternative to pars plana vitrectomy (PPV) in certain circumstances. PnR is an outpatient procedure and more cost-effective. However, its benefits should be judged alongside its success rate and adverse events. Herein, we compare the efficacy and safety of PnR and PPV for rhegmatogenous retinal detachment (RRD) repair. Methods We searched the PubMed, Scopus, EMBASE, Web of Science, Cochrane, and Google Scholar databases. Observational and interventional studies comparing the efficacy and safety of PnR and PPV were included. The outcomes were the success rate of the treatment, improvement in visual acuity, and adverse event rates. Subgroup analysis was performed based on the lens and macula status. Eleven articles were eligible to enter our study; these consisted of 11,346 patients with a mean age of 74.1. Results PnR was superior to PPV in terms of retinal displacement, photoreceptor integrity, visual function, and vertical metamorphopsia scores. In the meta-analysis, PPV showed higher a reattachment rate than PnR (OR = 3.39, 95% CI 2.25–5.11). Subgroup analysis showed that the advantage of PPV over PnR was more pronounced in studies with fewer phakic eyes, more macula-on patients, and in cases with primary PnR failure. While PnR patients had better pre-op (SMD = − 0.58, 95% CI = − 1.16 to 0.00) and post-op (SMD = − 0.45, 95% CI = − 0.60 to − 0.30) LogMAR, the improvement in visual acuity after surgery was higher in PPV patients (SMD = 0.49, 95% CI = − 0.15 to 1.13). Conclusion The success rate of PnR was higher in studies published after 2015 compared to previous studies (82% vs. 59%). Cataract formation and surgery were significantly higher in the PPV arm, while the occurrence of new retinal tears was more frequent in the PnR group. PnR can be used as the primary procedure for RRD repair in selected cases. However, we propose some modifications to the PIVOT criteria, e.g., the exclusion of cases presenting with several risk factors of poor outcomes.

Retinal displacement following the repair of rhegmatogenous retinal detachment (RRD) has been reported in recent studies. It was described as vertical movement of the retinal relative to its original location, as evidenced by retinal vessel printing on fundus autofluorescence imaging. This review reports the current literature on retinal displacement. We conducted an English literature search using Medline, PubMed, Embase, and Web of Science. We have reviewed 22 articles describing the diagnosis, frequency, and possible risk factors for retinal displacement. The reported rate of retinal displacement ranged from 6.4% to 62.8%, and the possible risk factors included the detachment-to-repair time, location and extent of RRD, macula-off RD, presence of subretinal fluid, use of perfluorocarbon, use of tamponade, postoperative facedown positioning, type of RRD repair, and presence of proliferative vitreoretinopathy, especially high grade. This review increases awareness of retinal displacement and its associated visual effects. [ABSTRACT FROM AUTHOR]

This case series demonstrates how subretinal fluid is displaced immediately after pneumatic retinopexy with a small gas bubble injection in the vitreous cavity for superior rhegmatogenous retinal detachment. This series highlights the significant impact of the buoyant force applied to the detached retina by intravitreal gas in achieving retinal reattachment. Purpose: To demonstrate how a small gas bubble injected into the vitreous cavity in pneumatic retinopexy for rhegmatogenous retinal detachment causes immediate displacement of subretinal fluid and to gain insights into the potential mechanism of retinal displacement. Methods: Three patients with rhegmatogenous retinal detachment who underwent pneumatic retinopexy were enrolled and prospectively followed. All patients underwent ultra-widefield fundus photography at baseline and at 1 to 2 minutes after intravitreal gas injection. Results: In all cases, the ultra-widefield fundus photograph demonstrated immediate displacement of subretinal fluid, suggesting that the buoyant force applied to the retina by the bubble was responsible for the displacement of subretinal fluid. The results were extrapolated to determine the buoyant force applied by a small and large gas bubble as in pneumatic retinopexy and pars plana vitrectomy. We determined that the buoyant force applied with a larger bubble in pars plana vitrectomy was substantially greater, and this may lead to retinal displacement. Conclusion: Intravitreal gas applies significant buoyant force to the detached retina and subretinal fluid that leads to substantial and rapid displacement of subretinal fluid. Understanding the affect of the buoyant force of the gas bubble on the detached retina can provide insight into possible mechanisms of retinal displacement. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Minimal gas vitrectomy with scleral buckle is a modification to standard pars plana vitrectomy and scleral buckle for rhegmatogenous retinal detachment, where a localized scleral buckle, pars plana vitrectomy, small volume expansile gas tamponade, and precise positioning may minimize retinal displacement and achieve a high-integrity retinal attachment. Purpose: To present a novel technique, minimal gas vitrectomy with scleral buckle, as a means of potentially minimizing retinal displacement compared with standard vitrectomy or vitrectomy/scleral buckle for select cases. Methods: A patient with right macula-off retinal detachment and retinal breaks at 7 o'clock and 10 o'clock underwent a 23-gauge pars plana vitrectomy, localization, and cryopexy of the breaks along with an inferior temporal segmental scleral buckle. No air–fluid exchange was performed. Suturing of sclerotomies, anterior chamber paracentesis of 0.3 mL, and intravitreal injection of 0.6 mL pure sulfur hexafluoride were then performed. The patient was advised to perform the steamroller maneuver with initial face-down positioning for 6 hours. Results: The patient achieved retinal reattachment, and postoperative wide-field fundus autofluorescence imaging demonstrated high-integrity retinal attachment with no retinal displacement. Conclusion: The minimal gas vitrectomy with scleral buckle technique has the potential to minimize retinal displacement in cases with inferior break(s) by using a small volume expansile gas tamponade and localized scleral buckle compared with standard vitrectomy or vitrectomy/scleral buckle with a full gas fill. [ABSTRACT FROM AUTHOR]

Background The appearance of hyperfluorescent lines next to the retinal blood vessels after successful retinal detachment (RD) surgery was explained by the occurrence of retinal displacement. This can attribute to the metamorphopsia experienced by some patients after their surgeries. Patients and methods A prospective interventional study was performed that included 30 eyes of 30 patients with primary rhegmatogenous RD, who had undergone successful RD surgery via pars plana vitrectomy and silicone oil tamponade. The entire patients had preoperative and postoperative fundus autofluorescence and optical coherence tomography. They were followed up for 3 months after surgery with testing of the best-corrected visual acuity and Amsler grid testing. Results The mean age of the included group was 53.7±9.2 years, and 17 (56.7%) patients were males. The most frequent tear site was upper temporal (43.3%), followed by multiple peripheral (23.33%), upper nasal (13.3%), lower temporal (13.3%), and the least was lower nasal (6.7%). Retinal displacement was detected by hyperfluorescent lines adjacent to the retinal blood vessels in the fundus autofluorescence imaging in 16 eyes (53.3% with 95% confidence interval: 36.7-70.0%). Patients with retinal displacement were significantly younger than patients without (P=0.019). The presence of proliferative vitreoretinopathy was significantly related to the occurrence of displacement (P=0.028). Metamorphopsia was significantly more frequent among patients with displacement (P<0.001). Conclusion Retinal displacement had a high possibility to occur after successful repair of primary rhegmatogenous RD. Young patients and patients with proliferative vitreoretinopathy are at a higher risk for displacement. [ABSTRACT FROM AUTHOR]

Introduction: Pneumatic retinopexy (PnR) was proposed as an alternative to pars plana vitrectomy (PPV) in certain circumstances. PnR is an outpatient procedure and more cost-effective. However, its benefits should be judged alongside its success rate and adverse events. Herein, we compare the efficacy and safety of PnR and PPV for rhegmatogenous retinal detachment (RRD) repair. Methods: We searched the PubMed, Scopus, EMBASE, Web of Science, Cochrane, and Google Scholar databases. Observational and interventional studies comparing the efficacy and safety of PnR and PPV were included. The outcomes were the success rate of the treatment, improvement in visual acuity, and adverse event rates. Subgroup analysis was performed based on the lens and macula status. Eleven articles were eligible to enter our study; these consisted of 11,346 patients with a mean age of 74.1. Results: PnR was superior to PPV in terms of retinal displacement, photoreceptor integrity, visual function, and vertical metamorphopsia scores. In the meta-analysis, PPV showed higher a reattachment rate than PnR (OR = 3.39, 95% CI 2.25–5.11). Subgroup analysis showed that the advantage of PPV over PnR was more pronounced in studies with fewer phakic eyes, more macula-on patients, and in cases with primary PnR failure. While PnR patients had better pre-op (SMD = − 0.58, 95% CI = − 1.16 to 0.00) and post-op (SMD = − 0.45, 95% CI = − 0.60 to − 0.30) LogMAR, the improvement in visual acuity after surgery was higher in PPV patients (SMD = 0.49, 95% CI = − 0.15 to 1.13). Conclusion: The success rate of PnR was higher in studies published after 2015 compared to previous studies (82% vs. 59%). Cataract formation and surgery were significantly higher in the PPV arm, while the occurrence of new retinal tears was more frequent in the PnR group. PnR can be used as the primary procedure for RRD repair in selected cases. However, we propose some modifications to the PIVOT criteria, e.g., the exclusion of cases presenting with several risk factors of poor outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Rhegmatogenous retinal detachment (RRD) repair with silicone oil (SO) tamponade has been observed to cause less retinal displacement than gas tamponade. Here, we assessed the mechanism and theoretical extent of retinal displacement in SO versus air tamponade in pars plana vitrectomy (PPV). Design Computer simulation model. Methods: Tamponade scale and subretinal scale simulation models previously developed were used to assess the physical forces, fluid dynamics and retinal deformations in SO versus air PPV. Results: When comparing a SO tamponade and an air tamponade occupying 93% of the ocular cavity, the SO tamponade has a Bond number that is an order of magnitude smaller and has a much lower contact angle (99° versus 125°) and contact pressure (0.0230 versus 1.44 mmHg). With a greater contact area and contact pressure, an air tamponade squeezes subretinal fluid away from contact points, displacing the retina by a maximum length of approximately 700 μm in our model. In contrast, for a SO tamponade, the contact pressure is much lower with a very small magnitude of retinal displacement (~ 50 μm). Conclusions: We showed that SO tamponade leads to significantly less retinal displacement than air tamponades. Although we do not recommend the routine use of primary SO because of its several disadvantages compared with gas, our findings can be further utilized to develop novel tamponade agents that minimize the risk of retinal displacement following RRD repair. [ABSTRACT FROM AUTHOR]

Purpose: To analyse the differences between 30° blue autofluorescence (BAF30), 55° blue autofluorescence (BAF55) and 200° green Ultra-Wide Field autofluorescence (UWF200) imaging to detect retinal displacement (RD) after vitrectomy surgery for rhegmatogenous retinal detachment (RRD). Methods: This cross-sectional study considers forty-nine consecutive patients who underwent RRD surgery in the time period 4–8 months previous to image acquisition. The exclusion criteria contemplate previous retinal pathology, under 18-year-olds and non-assessable images in any of the 3 devices. These images were analysed by two masked graders that assessed either the presence or absence of retinal displacement. A third observer reviewed the images that presented discordance. Results: A total of forty-nine patients were analysed. 7 eyes were excluded due to poor quality in either of the imaging modalities. The final analysis included 42 eyes of forty-two patients with a mean age of 60.3 ​± ​11.9 years. All patients underwent a 3 port 23-gauge pars plana vitrectomy as the technique of choice. Any grade of RD was detectable in 45.2% of images. It was similar between BAF30 and UWF200 (42.9% of eyes). BAF55 showed RD to a lesser extent (38.1%). Agreement index between BAF30 and BAF55 was 0.901, 0.903 between BAF30 and UWF200 and 0.803 between BAF55 and UWF200. Kappa agreement index between graders was 0.775 for BAF30, 0.798 for BAF50 and 0.808 for UWF200 images. Conclusions: All imaging modalities were able to detect RD after vitrectomy for RRD, with no inferiority of BAF30 and BAF55 over UWF200.

Purpose: Retinal displacement is common following rhegmatogenous retinal detachment (RRD) repair. A computer simulation was developed to assess forces applied by a gas tamponade of various sizes in the setting of pneumatic retinopexy (PnR) versus pars plana vitrectomy (PPV). Design: Computer simulation model. Methods: The contact angle and pressure between the tamponade and the retina were calculated using interfacial tension and the densities of gas and vitreous. A simulation determined the dynamics of fluid motion in the subretinal space and calculated deformations of the retina. Results: Bulk flow of fluid away from the tamponade in a direction along gravity stretched the retina and caused displacement in the simulations. Extent of displacement is attributable to the subretinal fluid layer thickness, and area of contact and contact pressure applied by the tamponade. Larger gas tamponades have greater contact pressure applied to the retina. Reducing gas bubble size from 93% to 6.25% with PPV versus PnR, there was a 79% reduction in the mean contact pressure (1.4 mmHg–0.29 mmHg), and a 93% reduction in the surface area of contact (11 cm2–0.8 cm2). Therefore, the contact force applied to the entire retina decreases by 97% from 83 mN (PPV) to 2.9 mN (PnR). The model resembling PnR had more than three times less displacement compared to PPV. Conclusions: This model provides a framework to study retinal displacement. Our findings suggest that proportional to their size, gas tamponades stretched the retina by displacing subretinal fluid following RRD repair. [ABSTRACT FROM AUTHOR]

Retinal displacement following rhegmatogenous retinal detachment (RRD) repair is an important consideration when assessing the integrity of reattachment, with potential implications on functional outcomes. There are limited data comparing various surgical techniques. We conducted a review of retinal displacement following RRD repair through October 2021, finding 21 studies encompassing 1,258 unique eyes. Outcome measures included the frequency of retinal displacement, visual acuity, metamorphopsia, and displacement direction. A meta-analysis was performed with data reported as risk ratios (RR) or mean difference and 95% confidence intervals. Retinal displacement was found in 35 ± 20% of RRD repairs. Scleral buckle (SB) without tamponade had the lowest rate of retinal displacement, followed by pneumatic retinopexy (PnR) and finally pars plana vitrectomy (PPV) (RR in PPV vs SB: 9.60 [2.01–45.95], P = 0.005). Silicone oil may reduce risk of displacement following PPV compared to gas (RR in gas vs SO: 2.16 [1.22–3.83], P = 0.009), as may immediate face-down positioning for 2 hours. Retinal displacement following PPV occurred in the downward direction in 92 ± 14% of cases and does not appear to significantly impact visual acuity (0.05 [-0.21 to 0.31], P = 0.70), although it may increase distortion. SB, PnR, PPV with silicone oil, and immediate face-down positioning are likely associated with less retinal displacement. Additional prospective studies are required to increase the certainty of these findings. [ABSTRACT FROM AUTHOR]

AIM: To explore retinal displacement after surgical treatment for idiopathic macular hole (IMH) with different internal limiting membrane (ILM) peeling patterns. METHODS: Totally 22 eyes from 20 patients with IMH were randomly allocated into two groups, N-T group (11 eyes) and T-N group (11 eyes). For patients in N-T group, ILM was peeled off from nasal to temporal retina. For patients in T-N group, ILM was peeled off from temporal to nasal retina. Preoperative, postoperative 1, 3, and 6mo, autofluorescence fundus images were collected for manual measurement of distances of fixed nasal (N), temporal (T), superior (S), and inferior (I) retinal points (bifurcation or crossing of retinal vessels) around the macula to the optic disc (OD). These were respectively defined as N-OD, T-OD, S-OD, and I-OD. The retinal displacement, macular hole closure rate, and best corrected visual acuity (BCVA) were compared between the two groups after surgery. RESULTS: At postoperative 1, 3, and 6mo, the macula slipped toward the OD, manifested by the decreased T-OD, N-OD, S-OD, and I-OD (P

• ERM peeling is an anatomically and functionally successful surgery in terms of visual improvement and retinal displacement in both iERMs and dERMs. • The presence of pre-operative SF and DRILs were higher in dERMs. • The presence of DRILs was associated with lower visual acuity in the dERM group. To compare the postoperative retinal displacement by optical coherence tomography (OCT) in idiopathic epiretinal membranes (iERM) and diabetic epiretinal membranes (dERM). This retrospective study included 36 iERM and 22 dERM cases. In cross-sectional OCT images (B-scan) the presence of foveal pit, subfoveal fluid, cotton ball sign (CBS), intraretinal cystic changes (ICC), disorganization of retinal inner layers (DRILs) and ectopic inner foveal layer (EIFL) were recorded. Central macular thickness (CMT) and EIFL thicknesses were calculated. Retinal displacement was quantified using infrared image of OCT approach consisting of the fovea to disc margin, interarcade distance and perimacular distances. The presence of subfoveal fluid (p = 0.014) and DRIL (p = 0.02) was significantly higher in the dERM group. CMT decreased significantly in both groups (p˂0.001). The EIFL was significantly thicker in the iERM group compared to the dERM group (p = 0.049), and it decreased significantly in the iERM group postoperatively. In the iERM group, while the fovea-disc margin distance decreased, the interarcade and perimacular distance increased significantly (p˂0.001). In the dERM group, the disc-fovea distance change was not significant (p = 0.082). Significant visual improvement was achieved with vitrectomy in both groups (p˂0.001). In the dERM group, the presence of DRIL was associated with lower pre and post-op visual acuity (VA) (r = 0.596 and p = 0.004 for pre-operative and r = 0.567 and p = 0.007 for post-operative). Significant retinal displacement occurs after vitrectomy in both iERM and dERM. The low VA in the dERM group may be related to the presence of DRILs. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the correlations of thickness of three retinal layers with retinal displacement after idiopathic macular hole surgery. Study design: Retrospective, consecutive, case series. Methods: 42 eyes of 42 patients undergoing macular hole surgery with internal limiting membrane peeling were studied. Retinal distance was measured with near-infrared images between the optic nerve and the intersection of retinal vessels at four quadrants. Retinal thicknesses of inner retinal layer, inner nuclear layer and outer retinal layer were measured 1000 μm away from the central fovea using Spectralis. Results: Retinal distances other than the nasal quadrant decreased postoperatively (p < 0.001). Retinal displacement (%) correlated significantly with the change in inner nuclear layer thickness in the temporal sector at 1, 3, and 6 months, in the superior sector at 2 weeks, 1, and 6 months, and in the inferior sector at 3 and 6 months postoperatively (r = 0.319–0.570, p < 0.001–0.040), but not in the inner or outer retinal layers. Conclusion: Internal limiting membrane peeling for macular hole enhances retinal displacement toward the optic disc, whose distances correlate with the changes in inner nuclear layer thickness. [ABSTRACT FROM AUTHOR]

Purpose: To determine the integrity of re-attachment in a macula-off detachment repaired with pars plana vitrectomy using perfluorocarbon liquid (PFO) assisted drainage and short-term tamponade with no air-fluid exchange and to discuss a unifying theory on the etiology of retinal malappositions including retinal displacement (stretch), retinal slippage and full-thickness macular folds. Observations: Significant retinal displacement was observed on fundus autofluorescence imaging following retinal detachment repair using PFO, along with significant metamorphopsia and aniseikonia. The retinal displacement was in the exact direction as the flow of subretinal fluid during the PFO assisted drainage. Conclusions and importance: Routine use of PFO to assist with drainage and leaving it in as a short-term tamponade for uncomplicated retinal detachment repair may result in inadvertent retinal displacement as a result of the forced flow of subretinal fluid leading to a stretch of the retina. This case supports a unifying theory on the etiology of retinal malappositions including retinal displacement (stretch), retinal slippage and full thickness macular fold. Retinal malappositions occur because of the flow of subretinal fluid either a) induced by the buoyant force of the tamponade and gravity in a direction related to post-operative head position (often towards inferior periphery) in the case of retinal displacement (stretch) or b) from anterior to posterior during air-fluid exchange in the case of full-thickness macular fold with posterior redundancy and anterior stretch or slippage.

Abstract Background Macular hole (MH) is a retinal break in the fovea involving partial or complete dehiscence of the neural retinal layers affecting the visual quality by decreasing visual acuity (VA) and visual deformation. We describe a case of secondary MH associated with submacular hemorrhage (SMH) due to polypoidal choroidal vasculopathy (PCV), which showed spontaneous closure. Case presentation A 67-year-old man developed decreased VA in his right eye due to an SMH. The VA was 20/50, and monthly intravitreal injection of aflibercept was administered three times. The SMH gradually decreased, and 10 months later the external limiting membrane was found to be perforated, resulting in MH. The old clot disappeared, and the MH remained for 10 months. Twenty-three months later, serous retinal detachment (SRD) involving the macula appeared and the MH had disappeared. SRD gradually disappeared, and macular configuration recovered. VA gradually improved and became 20/20 38 months later. Conclusion Dynamic change of the ultrastructure in an unusual case of secondary-developed and spontaneously closed MH was clearly observed. Although the mechanism was unknown, the small diameter size and exudative PCV are thought to have contributed to the closure.

Purpose: To evaluate the frequency of retinal displacement after pars plana vitrectomy (PPV) using silicone oil tamponade in patients with rhegmatogenous retinal detachment (RRD). Methods: Patients with fresh RRD were enrolled in this prospective interventional case series. A standard 3-port PPV with silicone oil tamponade was performed in all cases. A complete ocular examination, optical coherence tomography and fundus autofluorescence (FAF) imaging were performed at 1 and 3 months follow-up. Orthoptic examinations including synoptophore and light on–off tests were also performed at 3 months. Results: Twenty-three eyes from 23 patients with mean age of 56.6 ± 11 (range: 38–82) years were included. All patients were pseudophakic. Downward retinal displacement was found in 2 eyes (8.7%) showing hyperautofluorescent lines parallel to retinal vessels in FAF image. The patients with retinal displacement did not complain of metamorphopsia and did not show abnormality in orthoptic tests. Conclusion: Unintentional retinal shift following PPV with silicone oil tamponade for RRD is uncommon and might have little clinical significance. [ABSTRACT FROM AUTHOR]

Background: Macular hole (MH) is a retinal break in the fovea involving partial or complete dehiscence of the neural retinal layers affecting the visual quality by decreasing visual acuity (VA) and visual deformation. We describe a case of secondary MH associated with submacular hemorrhage (SMH) due to polypoidal choroidal vasculopathy (PCV), which showed spontaneous closure.Case Presentation: A 67-year-old man developed decreased VA in his right eye due to an SMH. The VA was 20/50, and monthly intravitreal injection of aflibercept was administered three times. The SMH gradually decreased, and 10 months later the external limiting membrane was found to be perforated, resulting in MH. The old clot disappeared, and the MH remained for 10 months. Twenty-three months later, serous retinal detachment (SRD) involving the macula appeared and the MH had disappeared. SRD gradually disappeared, and macular configuration recovered. VA gradually improved and became 20/20 38 months later.Conclusion: Dynamic change of the ultrastructure in an unusual case of secondary-developed and spontaneously closed MH was clearly observed. Although the mechanism was unknown, the small diameter size and exudative PCV are thought to have contributed to the closure. [ABSTRACT FROM AUTHOR]

Purpose: To determine the structural and functional outcomes of retinal displacement after epiretinal membrane surgery (ERM) with internal limiting membrane (ILM) peeling. Materials and Methods: The records of 56 eyes of 56 patients who underwent idiopathic ERM surgery were reviewed retrospectively. Change of fovea to optic disc (FOD) and interarcade distances (ID) at postoperative month 6 were evaluated for determination of the amount of retinal displacement. The integrity of external limiting membrane (ELM), ellipsoid zone (EZ) and cone outer segment tips (COST) and the presence of dissociated optic nerve fiber layer (DONFL) at month 6 were determined with optical coherence tomography. Corrected distance visual acuities (CDVAs) were measured before and 6 months after surgery. Results: Pre and postoperative FOD were 3668±284µ and 3555±268µ. Pre and postoperative ID were 7303±529µ and 7635±575µ. ELM was intact in 46 (82%) eyes, EZ in 38 (68%) eyes and COST in 38 (68%) eyes. DONFL was detected in 40 (71%) eyes. Mean pre and postoperative CDVA were logMAR 0.53±0.2 and 0.2±0.18. There was no correlation between postoperative CDVA and FOD change (Spearman's rho=0.136) and ID change (Spearman's rho=0.19). DONFL was significantly associated with FOD and ID change (p=0.013 ve p=0,02, respectively). Postoperative ELM-EZ and COST integrity were not associated with FOD and ID change. Conclusions: Macula seems to displace toward optic disc and expand in vertical direction following ERM and ILM peeling. There seems no correlation between retinal displacement and visual outcomes. Presence of DONFL may be related to increased retinal displacement. [ABSTRACT FROM AUTHOR]

Objective: To compare two different internal limiting membrane (ILM) peeling pattern on the retinal displacement after closure of idiopathic macular hole (IMH). Methods: Twenty-five eyes from 25 patients with idiopathic macular hole were randomly allocated into two groups, NS-to-TI group (13 eyes) and TI-to-NS (12 eyes) group. For patients in NS-to-TI group, ILM was peeled off from nasal-superior retina to temporal-inferior retina. For patients in TI-to-NS group, ILM was peeled off from temporal-inferior retina to nasal-superior retina. Baseline, 1 month, and 3 months after surgery, autofluorescence fundus images were collected for measurement of distance between macular hole or foveal center to margin of optic disc (FMD), temporal vessel to optic disc (T-OD), nasal vessel to optic disc (N-OD), vertical Interarcade distance (VIAD), horizontal Interarcade distance (HIAD), and perimacular area (PMA) based on the retinal vessels with bifurcation or crossing on retina. The retinal displacement, macular hole closure rate, and best corrected visual acuity (BCVA) were compared between the two groups after surgery. Results: At 1 and 3 months after surgery, the macular seemed slippery to optic nerve, which manifested by the decreased FMD, T-OD, N-OD, VIAD, HIAD, PMA(P<0.05); no significant difference was found in the FMD, T-OD, N-OD, VIAD, HIAD and PMA between NS-TI group and TI-NS group. Both group yield 100 % macular hole closure rate. no obvious difference was found in the postoperative BCVA between the two groups (P<0.05). Conclusion: The two different ILM peeling pattern showed similar visual outcome and retinal displacement, which means the surgeons can peel the ILM with different grasp site and different orientation. [ABSTRACT FROM AUTHOR]

Purpose: To assess the risk of retinal displacement after scleral buckle (SB) versus pars plana vitrectomy with SB (PPV-SB)., Design: Multicenter prospective nonrandomized clinical trial., Methods: The study took place at VitreoRetinal Surgery in Minneapolis, Minnesota, Sankara Nethralaya in Chennai, India, and St. Michael's Hospital in Toronto, Canada from July 2019 to February 2022. Patients who underwent successful SB or PPV-SB for fovea-involving rhegmatogenous retinal detachment with gradable postoperative fundus autofluorescence (FAF) imaging were included in the final analysis. Two masked graders assessed FAF images 3 months postoperatively. Metamorphopsia and aniseikonia were assessed with M-CHARTs and the New Aniseikonia Test, respectively. The primary outcome was the proportion of patients with retinal displacement detected with retinal vessel printings on FAF in SB versus PPV-SB., Results: Ninety-one eyes were included in this study, of which 46.2% (42 of 91) had SB and 53.8% (49 of 91) underwent PPV-SB. Three months postoperatively, 16.7% (7 of 42) in the SB group and 38.8% (19 of 49) in the PPV-SB group had evidence of retinal displacement (difference = 22.1%; odds ratio = 3.2; 95% confidence interval [CI], 1.2-8.6; P = 0.02) on FAF. The statistical significance of this association increased after adjustment for extent of retinal detachment, baseline logarithm of the minimum angle of resolution, lens status, and sex in a multivariate regression analysis (P = 0.01). Retinal displacement was detected in 22.5% (6 of 27) of patients in the SB group with external subretinal fluid drainage and 6.7% (1 of 15) of patients without external drainage (difference = 15.8%; odds ratio = 4.0; 95% CI, 0.4-36.9; P = 0.19). Mean vertical metamorphopsia, horizontal metamorphopsia (MH), and aniseikonia were similar between patients in the SB and PPV-SB groups. There was a trend to worse MH in patients with retinal displacement versus those without retinal displacement (P = 0.067)., Conclusions: Scleral buckle is associated with less retinal displacement compared with PPV-SB, indicating that traditional PPV techniques cause retinal displacement. There is a trend toward increased risk of retinal displacement in SB eyes that underwent external drainage compared with SB eyes without drainage, which is consistent with our understanding that the iatrogenic movement of subretinal fluid, such as that which occurs intraoperatively during external drainage with SB, may induce retinal stretch and displacement if the retina is then fixed in the stretched position. There was a trend to worse MH at 3 months in patients with retinal displacement., Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article., (Copyright © 2023 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

The management of rhegmatogenous retinal detachment has rapidly evolved over recent decades. A range of surgical techniques exist, all of which can achieve retinal reattachment in most cases. In recent years there have also been vast technical advances in retinal imaging that have introduced novel ways of visualizing and studying the retinal macro and microstructural anatomy following retinal detachment repair. Recent clinical trial data demonstrates that functional and patient-reported outcomes of retinal reattachment differ with surgical technique, accompanied by differences in anatomic biomarkers of retinal recovery or 'integrity'. We discuss recent insights into the physiology of retinal reattachment gleaned from multimodal imaging, which shed light on the pathophysiology of various post-operative anatomic abnormalities. The ideal scenario is to achieve retinal reattachment as soon as possible, without retinal displacement, outer retinal folds or discontinuity of the external limiting membrane, ellipsoid zone and interdigitation zone, with an intact foveal bulge. To this end, we present an in-depth contemporary account of current concepts and mechanisms involved during retinal reattachment surgery, supported by clinical data and mathematical modelling, awareness of which can help the vitreoretinal surgeon achieve better post-operative outcomes. In this review we substantiate the case for a paradigm shift in rhegmatogenous retinal detachment repair; beyond the emphasis on single-operation reattachment rates, and instead striving to maximize functional outcomes using minimally invasive techniques. This can only be achieved if vitreoretinal surgeons embrace all of the available techniques, with individualized selection of surgical approach and the resolute goal of optimizing the 'integrity' of retinal reattachment. [ABSTRACT FROM AUTHOR]

Purpose: To analyse the differences between 30° blue autofluorescence (BAF30), 55° blue autofluorescence (BAF55) and 200° green Ultra-Wide Field autofluorescence (UWF200) imaging to detect retinal displacement (RD) after vitrectomy surgery for rhegmatogenous retinal detachment (RRD)., Methods: This cross-sectional study considers forty-nine consecutive patients who underwent RRD surgery in the time period 4-8 months previous to image acquisition. The exclusion criteria contemplate previous retinal pathology, under 18-year-olds and non-assessable images in any of the 3 devices. These images were analysed by two masked graders that assessed either the presence or absence of retinal displacement. A third observer reviewed the images that presented discordance., Results: A total of forty-nine patients were analysed. 7 eyes were excluded due to poor quality in either of the imaging modalities. The final analysis included 42 eyes of forty-two patients with a mean age of 60.3 ​± ​11.9 years. All patients underwent a 3 port 23-gauge pars plana vitrectomy as the technique of choice. Any grade of RD was detectable in 45.2% of images. It was similar between BAF30 and UWF200 (42.9% of eyes). BAF55 showed RD to a lesser extent (38.1%). Agreement index between BAF30 and BAF55 was 0.901, 0.903 between BAF30 and UWF200 and 0.803 between BAF55 and UWF200. Kappa agreement index between graders was 0.775 for BAF30, 0.798 for BAF50 and 0.808 for UWF200 images., Conclusions: All imaging modalities were able to detect RD after vitrectomy for RRD, with no inferiority of BAF30 and BAF55 over UWF200., (© 2022 The Authors.)

Aim: To explore retinal displacement after surgical treatment for idiopathic macular hole (IMH) with different internal limiting membrane (ILM) peeling patterns., Methods: Totally 22 eyes from 20 patients with IMH were randomly allocated into two groups, N-T group (11 eyes) and T-N group (11 eyes). For patients in N-T group, ILM was peeled off from nasal to temporal retina. For patients in T-N group, ILM was peeled off from temporal to nasal retina. Preoperative, postoperative 1, 3, and 6mo, autofluorescence fundus images were collected for manual measurement of distances of fixed nasal (N), temporal (T), superior (S), and inferior (I) retinal points (bifurcation or crossing of retinal vessels) around the macula to the optic disc (OD). These were respectively defined as N-OD, T-OD, S-OD, and I-OD. The retinal displacement, macular hole closure rate, and best corrected visual acuity (BCVA) were compared between the two groups after surgery., Results: At postoperative 1, 3, and 6mo, the macula slipped toward the OD, manifested by the decreased T-OD, N-OD, S-OD, and I-OD ( P <0.05). No significant difference was found in the T-OD, N-OD, S-OD, and I-OD between N-T group and T-N group. IMH closure rate was 100% both in N-T group and T-N group. There was no significant difference in BCVA between two groups ( P <0.05)., Conclusion: The macula slips toward the OD after successful macular hole surgery. The two different ILM peeling pattern show similar visual outcome and retinal displacement, which means ILM peeling directions are not the influencing factor of postoperative retinal displacement., (International Journal of Ophthalmology Press.)

Purpose: To examine retinal displacement after vitrectomy with internal limiting membrane peeling for epiretinal membrane treatment, and to determine the correlation between the extent of displacement and the ganglion cell layer thickness changes., Methods: Thirty-nine consecutive patients were evaluated. Optical coherence tomography was performed preoperatively, and 2 and 6 months postoperatively. The distance between the fovea, the vessel intersection in the superior nasal, superior temporal, inferior nasal, and inferior temporal macular regions, and the optic disk were measured. Ganglion cell layer thickness was recorded., Results: The distance from the optic disk to the fovea and the superior nasal and inferior nasal vessel intersections significantly reduced at 2 and 6 months. Ganglion cell layer thickness significantly decreased in all the subfields (except nasal) at 6 months. A significant negative correlation was found between the change in the ganglion cell layer thickness and the movement of the fovea toward the optic disk. The ganglion cell layer thickness changes significantly correlated with retinal displacement., Conclusion: Retinal displacement toward the optic disk was detected after vitrectomy with internal limiting membrane peeling in eyes with epiretinal membrane. Ganglion cell layer thickness significantly reduced in all the subfields (except nasal). The extent of the displacement and the ganglion cell layer thickness changes showed significant negative correlation.